肺移植患者术后淋巴增生性疾病与胃肠道相关性:1例病例报道  

Gastrointestinal involvement of posttransplant lymphoproliferative disorder in lung transplant recipients:Report of a case

作　　者：Shitrit D. Shitrit A. B. -G. Dickman R. M.R. Kramer. 张欣(译) 史敏(校) 

机构地区：[1]不详 [2]Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petah Tikva, 49100, Israel

出　　处：《世界核心医学期刊文摘（胃肠病学分册）》2006年第6期18-19,共2页Core Journals in Gastroenterology

摘　　要：PURPOSE: Lymphoproliferative disorder is a well-recognized complication of lung transplantation. Risk factors include Epstein-Barr virus infection and immuno-suppression. The gastrointestinal manifestations of posttransplant lymphoproliferative disorder in lung transplant recipients have not been fully characterized. METHODS: Case presentation and 16 previously reported cases of posttransplant lymphoproliferative disorder with gastrointestinal involvement are reviewed. RESULTS: Patient ages ranged from 25 to 65 (median, 52) years. Median time fromlung transplantation to onset of posttransplant lymphoproliferative disorder was 36 (range, 1-109) months; 35 percent of cases (6/17) occurred within 18 months; Eighty-eight percent of patients (15/17) had positive Epstein-Barr virus serology before transplantation. In five patients (29 percent), the posttransplant lymphoproliferative disorder also involved sites other than the gastrointestinal tract. The most common gastrointestinal site of posttransplant lymphoproliferative disorder was the colon, followed by the small intestine and stomach. Clinical features included abdominal pain, nausea, and bloody diarrhea. Diagnosis was based on typical pathologic changes on gastrointestinal tract biopsy obtained mainly by colonoscopy. Treatment included a reduction in the immunosuppressive regimen in 15 of 17 cases (88 percent) and surgical resection in 10 (59 percent). One patient was untreated. Seven of 16 patients (44 percent) responded to treatment and 9 patients died. Median time from onset of posttransplant lymphoproliferative disorder to death was 70 (range,10-85) days. CONCLUSIONS: Posttransplant lymphoproliferative disorder with gastrointestinal involvement is a unique entity that should be considered in all Epstein-Barr-Virus-positive lung transplant recipients who present with abdominal symptoms. Although immunosuppressive modulation and resection can lead to remission, the risk of death is 50 percent.PURPOSE： Lymphoproliferative disorder is a well-recognized complication of lung transplantation. Risk factors include Epstein-Barr virus infection and immuno-suppression. The gastrointestinal manifestations of posttransplant lymphoproliferative disorder in lung transplant recipients have not been fully characterized. METHODS： Case presentation and 16 previously reported cases of posttransplant lymphoproliferative disorder with gastrointestinal involvement are reviewed. RESULTS： Patient ages ranged from 25 to 65 （median, 52） years. Median time fromlung transplantation to onset of posttransplant lymphoproliferative disorder was 36 （range, 1- 109） months; 35 percent of cases （6/17） occurred within 18 months; Eighty-eight percent of patients （15/17） had positive Epstein-Barr virus serology before transplantation. In five patients （29 percent）, the posttransplant lymphoproliferative disorder also involved sites other than the gastrointestinal tract. The most common gastrointestinal site of posttransplant lymphoproliferative disorder was the colon, followed by the small intestine and stomach. Clinical features included abdominal pain, nausea, and bloody diarrhea. Diagnosis was based on typical pathologic changes on gastrointestinal tract biopsy obtained mainly by colonoscopy. Treatment included a reduction in the immunosuppressive regimen in 15 of 17 cases （88 percent） and surgical resection in 10 （59 percent） . One patient was untreated. Seven of 16 patients （44 percent） responded to treatment and 9 patients died. Median time from onset of posttransplant lymphoproliferative disorder to death was 70 （range, 10- 85） days.

关 键 词：移植后淋巴增生性疾病 疾病患者 病例报道 胃肠道 肺移植 术后 EB病毒感染 血清学指标阳性 淋巴增生性病变 免疫抑制剂 

分 类 号：R699.2[医药卫生—泌尿科学] R128[医药卫生—外科学]